American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for convulsive status epilepticus?

1. Intravenous (IV) diazepam

2. Oral phenytoin

3. Intravenous (IV) lorazepam

4. Intramuscular midazolam

The correct answer is: Intravenous (IV) lorazepam

The first-line therapy for convulsive status epilepticus is intravenous (IV) lorazepam. This medication is preferred due to its rapid onset of action and longer duration of effect compared to other benzodiazepines. When administered intravenously, lorazepam quickly reaches the bloodstream and can effectively halt the seizure activity. In the setting of status epilepticus, it is crucial to achieve prompt seizure control to minimize the risk of neuronal injury and potential long-term complications. Lorazepam's pharmacokinetics allow it to provide immediate seizure suppression, making it the drug of choice in emergency situations. Other agents, such as intravenous diazepam, can also be used, but they have a shorter duration of action, which may necessitate repeated dosing. Oral phenytoin is generally not appropriate for initial treatment in an acute setting due to its delayed onset of action. Intramuscular midazolam can be used in certain contexts, particularly when IV access is unavailable, but it is not considered the first-line treatment for convulsive status epilepticus. Hence, intravenous lorazepam is the most effective and recommended initial therapy in this critical situation.